Conservative care effective long-term in type II elbow fractures

82% of patients with radial head fractures treated conservatively had no subjective complaints.

CHICAGO — Swedish investigators claim the clinical effectiveness of open reduction internal fixation with screws or wires to fix Mason type II radial head fractures remains unsubstantiated, even though the technique has become increasingly popular in the United States and Europe.

Instead, they recommended using conservative treatment in most cases, based on a study they conducted of long-term results with these fractures.

For those rare instances of a poor outcome or long-lasting pain, they also recommended later performing a radial head excision.

“Patients with type II Mason fractures of the radial head have, in the long-term perspective, good prognosis with conservative treatment,” said Pär Herbertsson, MD, in the department of orthopedics at University Hospital MAS, Malmo, Sweden. A Mason type II radial head fracture is non-comminuted and displaced 2 mm or more, he added.

Herbertsson presented the trial results at the American Academy of Orthopaedic Surgeons 73rd Annual Meeting, here.

Questionnaire, examination

At a mean follow-up of 19 years postinjury, investigators reviewed 49 patients with Mason type II radial head fractures treated from 1969 to 1979 at the only emergency department in Malmo, Sweden (34 women, 15 men). To be included in the study, all patients completed a questionnaire and then underwent a clinical examination. This allowed investigators to assess current outcome, including pain, flexion, extension and supination, and to compare that to their uninjured elbows.

When originally treated, all patients had Mason type II fractures; mean displacement 2.8 mm (range, 2 to 15 mm). Their mean age at fracture was 39 years; mean follow-up was 19 years (range, 14 to 24 years). In 24 cases, the right elbow was affected, compared to 25 cases of left elbow fractures. Most of the injuries were due to low-energy trauma such as from a fall or a direct blow to the radial head, he said.

The conservative methods primarily used included mobilization in seven patients and plaster casting for about two weeks in 42 patients. Four men and two women subsequently underwent excision of the radial head.

At long-term follow-up, “There were no subjective complaints in 40 individuals, or 82% [of the patients],” Herbertsson said. However, a few patients reported having pain when using their elbow or when it was at rest.

The mean flexion, extension and supination range of motion of the injured elbows was reduced at follow-up compared to the uninjured joints. In the injured vs. uninjured elbows, flexion was 137± 66° vs. 139 ± 67°, extension was –46 ± 11° vs. 1 ± 65° and supination was 85 ± 68° vs. 88 ± 64°.

In addition, 84% of injured elbows showed some signs of increased complications, including osteophytes, sclerosis or cysts, compared to 21% of the uninjured elbows (P<.01), he said.

For more information:
Herbertsson J, Josefsson PO, Hasserius, R, et al. Conservative treatment of displaced two-fragment fractures of the radial head. #85. Presented at the American Academy of Orthopaedic Surgeons 73rd Annual Meeting. March 22-26, 2006. Chicago.